11CRITERIA FOR VAGINAL DELIVERYFrank or complete breechEFW ggestational age >36 weeksfetal head must be flexedmaternal pelvis must be adequatejudged clinically or by pelvimetryno other maternal or fetal indiaction for CSexperienced obstetrician, anaesthetist and paediatrician present at delivery

12FACE PRESENTATIONIncidence: 0.2%Mechanics of presentation:Characterized by extreme extension of the fetal head so the face (rather than the skull) presents to the birth canalAetiologyany factor that favours extension such as fetal goitre, anencephalyhigh maternal parityAt diagnosis:60% mentoanterior15% mentotransverse25% mentoposterior

13BROW PRESENTATIONIncidence: 1:1400Mechanics of presentation:head is extended such that attitude is halfway between flexion (vertex) and hyperextension (face)usually transitional- when the head is in the process of converting from a vertex to a face or vice versapresenting part is between the facial orbits and anterior fontanellesupraoccipitomental diameter is presenting 13.5cm; cf 9.5cm for suboccipitobregmatic (vertex) or submentobregmatic (face)

15MANGEMENT occurs in up to 20% of casesExclude cord prolapseoccurs in up to 20% of casesOtherwise expectantmostly doesn’t interfere with normal deliveryvertex-foot: try to gently reposition the lower extremityif arm prolapses in vertex-hand, wait and see if it moves as head descends; if it converts to shoulder presentation, deliver by CS